Nueces County Research Articles

Abstract TP167: Short-Term Exposures to Ambient Air Pollution and Risk of Recurrent Ischemic Stroke

Background: Recurrent strokes are associated with poor outcomes and mortality. Short-term ambient air pollution may be an important environmental risk factor for stroke recurrence. Although associations between air pollution and stroke risk have been observed, the evidence for short-term effects of air pollution on risk of stroke recurrence is in its infancy. We investigated the association between short-term changes in ambient pollution (particulate matter <2.5μm (PM 2.5 ) and ozone (O 3 )) and the risk of recurrent ischemic stroke among individuals living in a bi-ethnic community. Methods: We identified recurrent ischemic stroke cases from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project, an ongoing population-based stroke surveillance study in Nueces County, Texas, between 2000 and 2012. Associations between lags of 0 to 3 days PM 2.5 and O 3 levels and odds of ischemic stroke were assessed using a time-stratified case-crossover design. Conditional logistic regression models were used to calculate odds ratios (ORs) for a 10 unit change in exposure. Results: There were 317 recurrent ischemic strokes with mean age of 72 years (SD=12). Median levels of PM 2.5 and O 3 over the study period were 7.7μg/m 3 (IQR: 5.6-10.7μg/m 3 ) and 35.2ppb (IQR: 25.0-46.1ppb), respectively. No associations were observed across the different lagged exposures (0 to 3 days) after adjusting for ambient temperature and relative humidity (Figure). Co-adjustment of both pollutants results did not change the results. Conclusion: No association between PM 2.5 and O 3 and risk of recurrences was observed. Research on the influence of air pollutants on risk of recurrence is still in its infancy, and more research is needed to understand the relation.

Neighborhood Influences on Emergency Medical Services Use for Acute Stroke: A Population-Based Cross-sectional Study

Delay to hospital arrival limits acute stroke treatment. Use of emergency medical services (EMS) is key in ensuring timely stroke care. We aim to identify neighborhoods with low EMS use and to evaluate whether neighborhood-level factors are associated with EMS use. We conducted a secondary analysis of data from the Brain Attack Surveillance in Corpus Christi project, a population-based stroke surveillance study of ischemic stroke and intracerebral hemorrhage cases presenting to emergency departments in Nueces County, TX. The primary outcome was arrival by EMS. The primary exposures were neighborhood resident age, poverty, and violent crime. We estimated the association of neighborhood-level factors with EMS use, using hierarchic logistic regression, controlling for individual factors (stroke severity, ethnicity, and age). During 2000 to 2009 there were 4,004 identified strokes, with EMS use data available for 3,474. Nearly half (49%) of stroke cases arrived by EMS. Adjusted stroke EMS use was lower in neighborhoods with higher family income (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.75 to 0.97) and a larger percentage of older adults (OR 0.70; 95% CI 0.56 to 0.89). Individual factors associated with stroke EMS use included white race (OR 1.41; 95% CI 1.13 to 1.76) and older age (OR 1.36 per 10-year age increment; 95% CI 1.27 to 1.46). The proportion of neighborhood stroke cases arriving by EMS ranged from 17% to 71%. The fully adjusted model explained only 0.3% (95% CI 0% to 1.1%) of neighborhood EMS stroke use variance, indicating that individual factors are more strongly associated with stroke EMS use than neighborhood factors. Although some neighborhood-level factors were associated with EMS use, patient-level factors explained nearly all variability in stroke EMS use. In this community, strategies to increase EMS use should target individuals rather than specific neighborhoods.

Abstract W P300: Ethnic Differences in Post-Stroke Quality of Life in the Brain Attack Surveillance in Corpus Christi (BASIC) Project

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs), which could translate into worse quality of life (QOL). Our objective was to investigate ethnic differences in post-stroke QOL across multiple domains in a bi-ethnic community. Methods: Ischemic stroke survivors, identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project in Nueces County, Texas, participated in in-person interviews 90 days post-stroke from May 2010 - June 2012. The validated short form stroke-specific QOL (SSQOL) was used to assess overall, physical, and psychosocial QOL; scores range from 1-5 with higher scores representing greater QOL. Tobit regression was used to model unadjusted associations between ethnicity and the 3 QOL domains. Models were then adjusted for the following demographic and clinical factors obtained from the medical record and patient interview: age, sex, education, insurance status, marital status, nursing home residence before stroke, prestroke modified Rankin scale, prestroke Informant Questionnaire on Cognitive Decline in the Elderly, initial NIH stroke scale, risk factors, BMI, and a comorbidity index. Results: A total of 335 ischemic strokes with complete data were identified (66% MA, 34% NHW). QOL was lower among MAs compared to NHWs, both overall (mean difference=-0.3, p=0.02) and in the physical domain (mean difference=-0.4, p=0.008); however, there was no difference in the psychosocial domain (p=0.22). After adjustment for demographic and clinical factors, MAs continued to experience poorer QOL compared to NHWs overall (mean difference=-0.5,p=0.049) and in the physical domain (mean difference=-0.3, p=0.006). Conclusions: Ethnic disparities in stroke outcome extend to QOL, with MAs experiencing substantially worse post-stroke QOL than NHWs. Interventions are urgently needed to improve stroke outcomes among the rapidly growing MA stroke population.

Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community. Methods: Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey. Results: A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs. Conclusions: Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.

Role of neurologists and diagnostic tests on the management of distal symmetric polyneuropathy.

Distal symmetric polyneuropathy (DSP) is a prevalent condition that results in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests in patient care is unknown. To determine how often neurologists and diagnostic tests influence the diagnosis and management of DSP in a community setting. In this retrospective cohort study, we used a validated case-capture method (International Classification of Diseases, Ninth Revision screening technique with subsequent medical record abstraction) to identify all patients with a new DSP diagnosis treated by community neurologists in Nueces County, Texas, who met the Toronto Diabetic Neuropathy Expert Group consensus criteria for probable DSP. Using a structured data abstraction process, we recorded diagnostic test results, diagnoses rendered (before and after testing), and subsequent management from April 1, 2010, through March 31, 2011. Changes in DSP cause and management after diagnostic testing by neurologists. We identified 458 patients with DSP followed up for a mean (SD) of 435.3 (44.1) days. Neurologists identified a cause of DSP in 291 patients (63.5%) before their diagnostic testing. Seventy-one patients (15.5%) had a new DSP cause discovered after testing by neurologists. The most common new diagnoses were prediabetes (28 [6.1%]), vitamin B12 deficiency (20 [4.4%]), diabetes mellitus (8 [1.7%]), and thyroid disease (8 [1.7%]). Management changes were common (289 [63.1%]) and usually related to neuropathic pain management (224 [48.9%]). A potential disease-modifying management change was made in 113 patients (24.7%), with the most common changes being diabetes management in 45 (9.8%), treatment with vitamins in 39 (8.5%), diet and exercise in 33 (7.2%), and adjustment of thyroid medications in 10 (2.2%). Electrodiagnostic testing and magnetic resonance imaging of the neuroaxis rarely led to management changes. Neurologists diagnosed the cause of DSP in nearly two-thirds of patients before their diagnostic testing. Inexpensive blood tests for diabetes, thyroid dysfunction, and vitamin B12 deficiency allowed neurologists to identify a new cause of DSP in 71 patients (15.5%). In contrast, expensive electrodiagnostic tests and magnetic resonance imaging rarely changed patient care.

Loss of the Mexican American survival advantage after ischemic stroke.

Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design. Active and passive surveillance were used to find all ischemic stroke cases from January 2000 to December 2011 in Nueces County, TX. Deaths were ascertained from the Texas Department of Health through December 31, 2012. Cumulative 30-day and 1-year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2011 and to calculate projected ethnic differences. There were 1974 ischemic strokes among non-Hispanic whites and 2439 among MAs. Between 2000 and 2011, model estimated mortality declined among non-Hispanic whites at 30 days (7.6% to 5.6%; P=0.24) and 1 year (20.8% to 15.5%; P=0.02). Among MAs, 30-day model estimated mortality remained stagnant at 5.1% to 5.2% (P=0.92), and a slight decline from 17.4% to 15.3% was observed for 1-year mortality (P=0.26). Although ethnic differences in 30-day (P=0.01) and 1-year (P=0.06) mortality were apparent in 2000, they were not so in 2011 (30-day mortality, P=0.63; 1-year mortality, P=0.92). Overall, mortality after ischemic stroke has declined in the past decade, although significant declines were only observed for non-Hispanic whites and not MAs at 1 year. The survival advantage previously documented among MAs vanished by 2011. Renewed stroke prevention and treatment efforts for MAs are needed.

Stroke risk after nonstroke emergency department dizziness presentations: a population-based cohort study.

Acute stroke is a serious concern in emergency department (ED) dizziness presentations. Prior studies, however, suggest that stroke is actually an unlikely cause of these presentations. Lacking are data on short- and long-term follow-up from population-based studies to establish stroke risk after presumed nonstroke ED dizziness presentations. From May 8, 2011 to May 7, 2012, patients ≥45 years of age presenting to EDs in Nueces County, Texas, with dizziness, vertigo, or imbalance were identified, excluding those with stroke as the initial diagnosis. Stroke events after the ED presentation up to October 2, 2012 were determined using the BASIC (Brain Attack Surveillance in Corpus Christi) study, which uses rigorous surveillance and neurologist validation. Cumulative stroke risk was calculated using Kaplan-Meier estimates. A total of 1,245 patients were followed for a median of 347 days (interquartile range [IQR] = 230-436 days). Median age was 61.9 years (IQR = 53.8-74.0 years). After the ED visit, 15 patients (1.2%) had a stroke. Stroke risk was 0.48% (95% confidence interval [CI] = 0.22-1.07%) at 2 days, 0.48% (95% CI = 0.22-1.07%) at 7 days, 0.56% (95% CI = 0.27-1.18%) at 30 days, 0.56% (95% CI = 0.27-1.18%) at 90 days, and 1.42% (95% CI = 0.85-2.36%) at 12 months. Using rigorous case ascertainment and outcome assessment in a population-based design, we found that the risk of stroke after presumed nonstroke ED dizziness presentations is very low, supporting a nonstroke etiology to the overwhelming majority of original events. High-risk subgroups likely exist, however, because most of the 90-day stroke risk occurred within 2 days. Vascular risk stratification was insufficient to identify these cases.

Abstract T P131: Residential Ethnic Segregation and Stroke Risk in Mexican Americans in the BASIC Project

Background: Neighborhoods with high racial-ethnic segregation may have weak community cohesion, low neighborhood trust, and high levels of stress which may impact stroke risk factors such as hypertension. We tested the hypothesis that greater residential ethnic segregation is associated with higher stroke risk in a bi-ethnic community. Methods: Strokes were identified from the BASIC Project in Nueces County, Texas from 2000-2010. Residential ethnic segregation (range: 0-1) was derived for each census tract (used to define neighborhoods) in the county based on 2000 census data. The measure reflects the probability that a Mexican American (MA) shares their neighborhood with another MA and was categorized into: 1) predominantly non-Hispanic white (NHW, <0.3), 2) ethnically mixed (0.3-0.7), or 3) predominately MA (>0.7). Poisson models were used to examine the association between residential ethnic segregation and stroke risk unadjusted and adjusted for age, sex, ethnicity and neighborhood income. Effect modification by ethnicity was examined in the fully adjusted model, and models were run stratified by ethnicity. Results: A total of 2,857 strokes were included. Median residential ethnic segregation was 0.52 (IQR: 0.38-0.77). In the unadjusted model, predominately MA census tracts had greater stroke risk than predominantly NHW census tracts [ethnically mixed: RR=1.23 (95% CI: 1.12-1.35); predominately MA: RR=1.67 (95% CI: 1.51-1.83)]. After adjustment, residential ethnic segregation was not associated with stroke risk [ethnically mixed: RR=1.00 (95% CI: 0.71-1.42); predominately MA: RR=1.11(95% CI: 0.76-1.61)]. Effect modification by ethnicity was not significant (p=0.37), but in the stratified model limited to MAs, predominately MA census tracts had a trend toward higher stroke risk compared to MAs living in predominately NHW census tracts [RR=1.41 (95% CI: 0.94-2.12)] after adjustment for demographics and neighborhood income. Conclusions: Stroke risk for MAs was greater in neighborhoods with high ethnic segregation than in predominantly NHW neighborhoods suggesting that features of highly segregated neighborhoods may contribute to elevated stroke risk in MAs.

Soil Loss Due to Residue Removal in the Oso Creek Watershed, Texas

The SWAT model was used to quantify soil erosion losses in surface runoff caused by sorghum residue removal for bioenergy production in the Oso Creek watershed in Nueces County, Texas. The model simulated the removal of 25%, 50%, 75%, and 100% of the residue, and the results were compared to the NRCS tolerable soil loss limit of 11.21tonnes ha-1 year-1 (5 tons acre-1 year-1) for the study area. The analysis found that maximum soil loss of 2.78 tonnes ha-1 (1.24 tons acre-1) occurred during the final year of a ten-year simulation in which 100% of the sorghum residue was removed. Therefore, grain sorghum residue can be completely removed from the Upper Oso Creek watershed without causing soil losses to exceed the tolerable limits of 11.21 tonnes ha-1 year-1 (5 tons acre-1 year-1). However, nutrient losses from residue removal will have to be replaced by fertilizer applications in order to maintain soil productivity. In addition, total residue removal is not recommended on an annual basis since this would deplete organic carbon levels in the soil and reduce soil quality and future productivity.

Use of BPPV Processes in Emergency Department Dizziness Presentations

A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed and cured with the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We aimed to describe the use of these processes in emergency departments (EDs), assess for trends in use over time, and determine provider level variability in use. Prospective population-based surveillance study. Emergency departments in Nueces County, Texas, from January 15, 2008, to January 14, 2011. Adult patients discharged from EDs with dizziness, vertigo, or imbalance documented at triage. Clinical information was abstracted from source documents. A hierarchical logistic regression model adjusting for patient and provider characteristics was used to estimate trends in DHT use and provider-level variability. A total of 3522 visits for dizziness were identified. A DHT was documented in 137 visits (3.9%). A CRM was documented in 8 visits (0.2%). Among patients diagnosed with BPPV, a DHT was documented in only 21.8% (34 of 156) and a CRM in 3.9% (6 of 156). In the hierarchical model (c-statistic = 0.93), DHT was less likely to be used over time (odds ratio, 0.97; 95% confidence interval, 0.95-0.99), and the provider level explained 50% (intraclass correlation coefficient, 0.50) of the variance in the probability of DHT use. Benign paroxysmal positional vertigo is seldom examined for and, when diagnosed, infrequently treated in this ED population. Use of the DHT is decreasing over time and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize management in ED dizziness presentations.

Capturing cases of distal symmetric polyneuropathy in a community

Little is known about what constitutes appropriate diagnostic testing in patients with distal symmetric polyneuropathy (DSP). Utilizing an ICD-9 screening method and medical record abstraction, we determined the number of new cases of DSP within community neurology practices in Nueces County, Texas. We then compared 2 case capture methods (ICD-9 vs. all-case review screening). The ICD-9 case capture method identified 52 cases over a 3-month period. Comparing case capture methods, the ICD-9 method identified 16 of 17 cases identified by the all-case review method (94%). The ICD-9 method required screening of 84% fewer charts compared with the all-case review. Many new cases of DSP occur each month within Nueces County. The ICD-9 screening technique combined with medical abstraction is an efficient method to identify new DSP cases in this community. These findings are critical for future epidemiological investigations into patients with DSP.

The Use of the Dix-Hallpike Test and the Canalith Repositioning Maneuver in Emergency Department Dizziness Presentations: A Population-Based Study (P02.250)

Objective: To describe the use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM) in a population-based emergency department (ED) dizziness study. Background A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed with the DHT and treated with the CRM. No prior studies have assessed the use of these processes in ED dizziness presentations. Design/Methods: From January 15, 2008 to January 14, 2011, adult patients presenting to the ED in Nueces County, Texas, with dizziness, vertigo, or imbalance documented at triage were identified by review of ED logs, excluding those admitted to the hospital. Clinical information was abstracted from source documents. A hierarchical logistic regression model was fitted to estimate trends in DHT use and evaluate provider variability in DHT use. Results: 3,525 dizziness patients were identified. A DHT was documented in 137 visits (3.9%). The side tested was reported in 51 (37%). The DHT results were positive in 94 visits, negative in 37, and not documented in 6. Results were based on symptoms in 23, nystagmus in 21, and unknown in 93. None of the positive DHTs documented the characteristic pattern of BPPV nystagmus and only 47.9% (45 of 94) documented the affected side. A CRM was performed in only 8 visits. In the hierarchical model, every increase in month was associated with a 2% decrease in the use of the DHT (p=0.04), and the provider level explained more than 50% (ICC, 0.54) of the variance in DHT use. Conclusions: The DHT and CRM are used infrequently in this population. When documented, details about the technique and results are sparse. DHT use is decreasing over time, and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize the efficiency and effectiveness of care in ED dizziness presentations. Supported by: NIHK23RR024009. Disclosure: Dr. Kerber has received personal compensation for activities with Munson Medical Center, Weinberg Group, Estes, Ingram, Foels & Gibbs as a speaker and/or consultant. Dr. Meurer has nothing to disclose. Dr. Brown has received compensation and/or their research work has been funded, entirely or in part, by a grant to their university. The grant agreement requires that the name of the funding entity and the purpose of the grant may not be disclosed. The funding entity is a governmental organization. Dr. Lisabeth has nothing to disclose. Dr. Callaghan has nothing to disclose. Dr. Fendrick has received personal compensation for activities with Abbott Laboratories, Inc., ActiveHealth Management, GlaxoSmithKline, Inc., Hewitt Associates, MedImpact HealthCare Systems Inc., Merck & Co., Inc., Novartis, and Perrigo as a consultant. Dr. Fendrick has received personal compensation in an editorial capacity for The American Journal of Managed Care. Dr. Fendrick has received research support from AstraZeneca Pharmaceuticals, Pfizer Inc, and Sanofi-Aventis Pharmaceuticals, Inc. Dr. Morgenstern has nothing to disclose.

Fatalism, Optimism, Spirituality, Depressive Symptoms, and Stroke Outcome

We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality. Stroke cases from June 2004 to December 2008 were ascertained in Nueces County, TX. Patients without aphasia were queried on their recall of depressive symptoms, fatalism, optimism, and nonorganizational spirituality before stroke using validated scales. The association between scales and stroke outcomes was studied using multiple linear regression with log-transformed National Institutes of Health Stroke Scale and Cox proportional hazards regression for recurrence and mortality. Six hundred sixty-nine patients participated; 48.7% were women. In fully adjusted models, an increase in fatalism from the first to third quartile was associated with all-cause mortality (hazard ratio, 1.41; 95% CI, 1.06-1.88) and marginally associated with risk of recurrence (hazard ratio, 1.35; 95% CI, 0.97-1.88), but not stroke severity. Similarly, an increase in depressive symptoms was associated with increased mortality (hazard ratio, 1.32; 95% CI, 1.02-1.72), marginally associated with stroke recurrence (HR, 1.22; 95% CI, 0.93-1.62), and with a 9.0% increase in stroke severity (95% CI, 0.01-18.0). Depressive symptoms altered the fatalism-mortality association such that the association of fatalism and mortality was more pronounced for patients reporting no depressive symptoms. Neither spirituality nor optimism conferred a significant effect on stroke severity, recurrence, or mortality. Among patients who have already had a stroke, self-described prestroke depressive symptoms and fatalism, but not optimism or spirituality, are associated with increased risk of stroke recurrence and mortality. Unconventional risk factors may explain some of the variability in stroke outcomes observed in populations and may be novel targets for intervention.

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.

Abstract P1-10-13: Mexican American Men and Female Cancer Screening: Is the TexasMexico Border Different?

Abstract Background Husband/partner support is a major determinant of breast/cervical cancer screening in Hispanic women and may adversely affect these rates in south Texas border communities. The Esperanza y Vida/Life Skills project is a pilot, community based, breast/cervical cancer education, screening, and treatment program for Hispanic women and men. The current study evaluated knowledge, attitudes and beliefs (KAB) about breast/cervical cancer screening among Mexican American men in 3 border communities. Methods Semi-structured, bilingual interviews were conducted in male focus groups held in Laredo, Eagle Pass and Nueces County Texas. Audiotaped interviews were transcribed, coded and content analysis used to identify themes across codes. Each participant completed a bilingual survey of beast/cervical cancer KAB. Results 27 male participants median age 59y (range 26-91y; age distribution <50-29%, 50-69 37%, 70+-33%) were recruited by our community partners. 85.2% had lived at their current residence >2y. 56% had less than a high school education and 14.8% had no education. Annual household income was less than $10,000 in 59% and 63% were unemployed. Bumping/bruising and touching the breast were believed to increase breast cancer risk in 41% and 33% of men respectively. While 55.5% correctly identified family history as a breast cancer risk factor only 25.9% identified age. Only 11/27 (42.6%) associated advancing age with an increased likelihood of cervical cancer. Clinical breast exam and Pap testing frequency were correctly identified by 51.8% and 41% of men respectively. Qualitatively, men feared cancer and were likely to have a fatalistic view of it. They expressed some knowledge of breast and cervical cancer, but also had questions and concerns about it. Performance of screening exams by male providers did not pose a barrier but the men preferred that female nurses be present during sensitive exams. They did not express any jealousy or negative feelings towards having their wives screened by males. The men recognized the importance of cancer screening and actively supported screening in their spouses. Screening and early detection were important to keep the family together as was support for women who had cancer. Men felt it was important for them to ‘push’ their wives to get screened. They expressed concern about limited community resources for cancer information and mainly identified clinics, physicians and hospitals as primary cancer information resources. The men identified a need for more primary care physicians who had cancer screening service access. They were embarrassed about teaching their daughters about breast and cervical cancer screening and felt that was more of the mother's role. Conclusions Men in Texas-Mexico border communities were willing to openly discuss breast and cervical cancer. They recognized the importance of cancer screening, family education/awareness and actively support screening in their spouses. Male providers did not pose a barrier to cancer screening for Mexican men. The men have some knowledge, but would benefit from additional information and resources within their communities. Addressing cultural barriers, knowledge issues and access will be helpful in these communities. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-13.

Fast food and neighborhood stroke risk

To investigate the association between the number of fast food restaurants and ischemic stroke in neighborhoods. This work was a prespecified part of the Brain Attack in Corpus Christi (BASIC) project. Ischemic stroke cases were prospectively ascertained in Nueces County, Texas. Home addresses were geocoded and used to establish the census tract for each stroke case. Census tracts were used as proxies for neighborhoods (n = 64). Using a standard definition, fast food restaurants were identified from a commercial list. Poisson regression was used to study the association between the number of fast food restaurants in the neighborhood, using a 1-mile buffer around each census tract, and the risk of stroke in the neighborhood. Models were adjusted for demographics and neighborhood socioeconomic status (SES). There were 1,247 completed ischemic strokes from January 2000 through June 2003 and 262 fast food restaurants. The median number of fast food restaurants per census tract including buffer was 22 (interquartile range, 12-33). Adjusting for neighborhood demographics and SES, the association of fast food restaurants with stroke was significant (p = 0.02). The association suggested that the risk of stroke in a neighborhood increased by 1% for every fast food restaurant (relative risk, 1.01; 95% confidence interval [CI], 1.00-1.01). The relative risk of stroke comparing neighborhoods in the 75th to the 25th percentile of the distribution of fast food restaurants was 1.13 (95% CI, 1.02-1.25). Controlling for demographic and SES factors, there was a significant association between fast food restaurants and stroke risk in neighborhoods in this community-based study.

What Do Toilets Have to Do With It? Health, the Environment, and the Working Poor in Rural South Texas Colonias

This paper develops and tests an environmental health ecological framework between the quality of infrastructure, utilities and resident’s practices to health problems reported in three Nueces County, Texas colonias. Populated by predominantly low-income, minority families, these peri-urban settlements are characterized by substandard housing, lacking traditional sewage systems, potable drinking water and pluvial drainage. It was hypothesized that those without indoor toilets, pluvial drainage and regular garbage collection would be more likely to report health problems. The study found that keeping trash for over a week was statistically related to gastrointestinal illness and eye infections. Having indoor toilets in conjunction with substandard septic tanks was statistically related to gastrointestinal illness, respiratory problems and skin infections. The lack of pluvial drainage was statistically significantly, while not related to a particular disease. The argument is made that flooding problems may have contributed to the sanitation problems. Specifically, drainage problems affect the septic tanks and cause backflow to the indoor toilets. Although a small sample, the findings show that people who live in colonias are at risk for disease because structural measures to improve sanitation are not available.

Participation in Physical Activity Among Normal‐ and Overweight Hispanic and Non‐Hispanic White Adolescents

The purpose of this study was to determine the relation between weight status and participation in physical activity (PA) among Hispanic and non-Hispanic white (NHW) adolescent boys and girls. In this cross-sectional study, height and weight were measured and a modified 2001 Youth Risk Behavior Survey was administered to 1,302 Hispanic and NHW adolescents, aged 14-17 years, attending high school in Nueces County, Texas. Linear regression analysis was used to assess the relation between weight status (normal weight or "at risk for overweight and overweight" [AR&O]) and PA, including moderate PA, vigorous PA, strength training, participation in team sports, and TV viewing, according to gender and ethnicity. Thirty-eight percent of adolescents were AR&O, including 32% and 48% of Hispanic girls and boys, respectively, and 22% and 35% of NHW girls and boys, respectively. As expected, boys reported participating in more PAs than girls. Compared with NHW girls, both normal weight and AR&O Hispanic girls reported significantly fewer bouts of moderate activity, less involvement in team sports, and more time watching TV. Normal weight boys reported participating in significantly more vigorous activity than those who were AR&O. Hispanic boys reported more strength training than NHWs; however, they watched significantly more hours of TV than NHW boys. Hispanic and NHW high school students reported participation in different PAs; this information may be useful for planning health and physical education curriculum.

Detection and Evolution of Resistance to the Pyrethroid Cypermethrin in <I>Helicoverpa zea</I> (Lepidoptera: Noctuidae) Populations in Texas

The bollworm, Helicoverpa zea (Boddie), is a key pest of cotton in Texas. Bollworm populations are widely controlled with pyrethroid insecticides in cotton and exposed to pyrethroids in other major crops such as grain sorghum, corn, and soybeans. A statewide program that evaluated cypermethrin resistance in male bollworm populations using an adult vial test was conducted from 2003 to 2006 in the major cotton production regions of Texas. Estimated parameters from the most susceptible field population currently available (Burleson County, September 2005) were used to calculate resistance ratios and their statistical significance. Populations from several counties had statistically significant (P < or = 0.05) resistance ratios for the LC(50), indicating that bollworm-resistant populations are widespread in Texas. The highest resistance ratios for the LC(50) were observed for populations in Burleson County in 2000 and 2003, Nueces County in 2004, and Williamson and Uvalde Counties in 2005. These findings explain the observed pyrethroid control failures in various counties in Texas. Based on the assumption that resistance is caused by a single gene, the Hardy-Weinberg equilibrium formula was used for estimation of frequencies for the putative resistant allele (q) using 3 and 10 microg/vial as discriminatory dosages for susceptible and heterozygote resistant insects, respectively. The influence of migration on local levels of resistance was estimated by analysis of wind trajectories, which partially clarifies the rapid evolution of resistance to cypermethrin in bollworm populations. This approach could be used in evaluating resistance evolution in other migratory pests.

Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department: A Population-Based Study: Kerber KA, Brown DL, Lisabeth LD, et al. Stroke 2006;37:2484–7

As part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, this study sought to determine the percentage of stroke patients who presented to the Emergency Department (ED) with the complaints of dizziness, vertigo, or imbalance. This large population-based study examined all patients over the age of 44 years who presented to the ED or were directly admitted to the hospital between January 2000 and June 2003 with the previously mentioned isolated dizziness symptoms (DS) in Nueces County, Texas.